Methotrexate vs. biologics – which is more effective as a first-line treatment?

This study investigated the effectiveness of methotrexate (MTX) versus tocilizumab (TCZ) in early rheumatoid arthritis (RA). 

They found that TCZ patients had a greater reduction in disease activity (DA).

Rheumatoid arthritis (RA) is a chronic condition. It is caused by excessive inflammation leading to painful swelling in the joints. RA is managed using medication to reduce inflammation. These drugs are called disease-modifying anti-rheumatic drugs (DMARDs). The aim of treatment is to lower disease activity (DA) or achieve remission. When a patient is diagnosed with RA, they are usually prescribed methotrexate (MTX). MTX is a synthetic DMARD (csDMARD) that reduces inflammation via multiple mechanisms. It is usually combined with a glucocorticoid (GC) drug such as prednisone (Deltasone). A combination of MTX and GC is usually effective in managing early RA.

Some studies suggest that a biological DMARD (bDMARD) may be more effective as a first-line treatment. bDMARDs are costly and are not usually used as FLT. Tocilizumab (Actemra; TCZ) is a bDMARD. It targets a chemical called interleukin 6 (Il-6). It is unclear if TCZ is more effective than MTX at lowering DA in patients with RA.

This study analyzed data from 2 clinical trials. This included 553 patients with early RA. Patients were taking MTX, TCZ or both. Some patients also took prednisone (PDN). The authors compared DA across the studies. DA was measured using standard RA rating scales. Follow-up was performed up tp 2 years.

Patients treated with MTX + TCZ had lower DA scores compared to MTX + PD. TCZ-treated patients had greater reductions in DA scores. This is compared to patients treated with MTX. Remission rates were similar in TCZ and MTX patients at 2 years. The safety outcomes were similar across treatment combinations.

The authors concluded that TCZ-treated patients had a greater reduction in DA.

Remission rates were similar at 2 years. MTX may still be more appropriate as a first-line treatment. More investigation in early RA is needed.

If you have any concerns regarding RA treatment, please consult with your doctor.